Exploring the Adaptive and Interpretive Dynamics of Implementation in Infection Prevention Abstract Infections acquired by patients during the course of receiving treatment within a healthcare setting, known as healthcare-associated infections (HAIs), are one of the most common complications of hospital care in the United States. They exact a tremendous toll in morbidity, mortality and costs. Various simple, evidence-based guidelines are available to hospitals and clinicians to use in the prevention of HAIs. Despite the existence of these infection prevention measures, a puzzle remains: many hospitals have not adopted them and even when they do, face considerable challenges in getting healthcare workers to consistently use them. The gap between what should be done to prevent HAIs and what is actually done is a critical barrier to improvement in infection prevention. Yet little systematic knowledge about the dynamics of implementation in infection prevention exists. What is known largely comes from retrospective accounts of the implementation process. As a result, there is a gap in our knowledge about the way in which organizational change in infection prevention actually occurs over time. The purpose of this dissertation project is to explore the experience of one hospital as it implements an organization-wide infection prevention initiative in order to identify barriers and facilitators to successful organizational change. The project has three primary aims: 1) To describe the dynamic process of adaptation to local context in the implementation of an infection prevention initiative with a focus on how change happens and is sustained over time 2) To identify how hospital staff interpret and make sense of changes to infection prevention practice and to understand how these interpretations influence the actions staff take to implement changed practices into their everyday work, and 3) To develop and refine theoretical ideas relating to the adaptive and interpretive dynamics of implementation in infection prevention by examining how they vary by type of HAI, unit culture and structure, professional identity of frontline staff and the strength of the evidence base available for the prevention practice. The project is a 2-year multi-method qualitative case study of one hospital that is undertaking a "Preventing HAI" initiative to reduce the rates of these infections. Methods will include ethnographic observations of initiative activities and in-depth interviews with two groups of hospital employees at multiple points in time: those involved in planning and implementing the initiative and frontline clinical staff. This study will generate knowledge about the implementation process that can be used to improve the design of implementation strategies for evidence-based infection prevention practices in other healthcare organizations. Improving implementation of evidence-based infection prevention practices is important because the consistent use of these practices can help reduce rates of HAIs transmitted to patients. The reduction and eventual elimination of these infections will improve the quality, safety and cost- effectiveness of care delivered to hospitalized patients. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to public health, policy and practice because it will generate knowledge that can be used to improve the design of strategies to implement evidence-based infection prevention practices. Improving implementation of these practices is important because the consistent use of these practices can help reduce rates of HAIs transmitted to patients. The reduction and eventual elimination of these infections will improve the quality, safety and cost-effectiveness of care delivered to hospitalized patients.